Transplantation in adults with primary hyperoxaluria: single unit experience and treatment algorithm

Area of Science:

• Nephrology
• Hepatology
• Transplantation Immunology

Background:

• Primary Hyperoxaluria (PH) is a genetic disorder causing kidney damage.
• Kidney transplantation alone for PH has high recurrence and graft loss rates.
• Liver transplantation can correct the underlying metabolic defect in PH.

Observation:

• A retrospective review of five PH patients undergoing transplantation was conducted.
• Three patients received kidney-only transplants; two received sequential liver-kidney transplants.
• Kidney-only transplants showed poor outcomes, with all three failing.

Findings:

• Two patients who underwent sequential liver-kidney transplantation remain well at 1 and 3 years post-transplant.
• One patient who received a combined liver-kidney transplant is well at 4 years.
• Kidney-only transplant recipients experienced graft failure, necessitating retransplantation or awaiting further transplants.

Implications:

• Combined liver-kidney transplantation may be a superior primary approach for PH.
• The optimal timing and strategy for liver transplantation in PH require further investigation.
• Sequential liver-kidney transplantation demonstrates promising results for managing PH.